Presentation and Clinical Features of the Sellar Region Meningiomas

Although meningiomas may present with hemorrhage and epilepsy, most exert local pressure effects, and this is especially true of sellar-region tumors.

Tuberculum sellae (suprasellar) meningiomas arise from the meninges of the anterior clinoid or tuberculum sellae. They displace the optic nerves and chiasm upwards or backwards. They present with visual failure involving a central scotoma in conjunction with an asymmetrical bitemporal field loss. Some degree of optic atrophy is usually present and this, in conjunction with lack of papilledema or anosmia, helps to distinguish this tumor from an olfactory groove meningioma. Backward growth of the tumor may impinge upon the hypothalamic-pituitary axis and produce endocrinological deficits. Cavernous sinus (parasellar) meningiomas present with retro-orbital pain and sixth cranial nerve palsy. The other cranial nerves in the area - III and IV - may also be affected. The first and second division of the fifth cranial nerve may also be involved. Anterior clinoid and medial third sphenoid wing (parasellar) meningiomas generally present with progressive loss of vision and optic atrophy on examination. There is unilateral loss of acuity due to optic nerve compression; this may be seen in conjunction with an incongruous field loss resulting from an element of chiasmal compression. Tumors growing "en plaque" may invade the cavernous sinus and produce the features mentioned above.

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.